An unusual case of metastatatic renal cell carcinoma presenting as melena and duodenal ulcer, 16 years after nephrectomy; a case report and review of the literature

Abstract

Renal cell carcinoma comprises about 2% of adult tumors. The overall 10-year survival rate of patients with RCC after nephrectomy is about 18-27%. The incidence of metastasis of initial RCC is about 24-28%, but this rate after nephrectomy is as high as 51%. The most common site of recurrence is the lung, however liver and bone metastases are common. There are many reported cases with late metastasis, however isolated late metastasis in the gastrointestinal tract especially duodenum is very rare. Herein we report our experience with a case of gastrointestinal bleeding secondary to metastatic renal cell carcinoma to duodenum, 16 years after nephrectomy. To the best of our knowledge, about 30 of such cases have been reported in the English literature. Many of the previous cases have been part of disseminated disease and isolated duodenal metastasis is very rare. The longest reported duration between nephrectomy for renal cell carcinoma and duodenal metastasis has been 13 years, thus it seems our case to be also unique because of very late duodenal metastasis.

Keywords: Duodenal ulcer; Gastrointestinal hemorrhage; Pancreaticoduodenectomy; Renal cell carcinoma.

Figure 1

(A and B) Endoscopy of the duodenum shows ulcers (Arrows).

Figure 2

High and low power view of duodenal ulcer biopsy show collections of clear cells. (A: H&E ×100, B: H&E ×250).

Figure 3

Immunohistochemistry was positive for cytokeratin (A) and vimentin (B).

Figure 4

Abdominal CT scan shows pancreaticoduodenal mass and absence of right kidney.

Figure 5

Gross specimen of the duodenal mass shows relatively well defined mass beneath the small intestinal wall (arrows show mucosa of duodenum).

Figure 6

Sections from ampulla of vater show subepithelial tumoral tissue with clear cell morphology. (H&E ×100)